Assessment of Non-linear Imputation of PaO2/FiO2 from SpO2/FiO2 Among Patients Receiving Mechanical Ventilation in China

Assessment of Non-linear Imputation of PaO2/FiO2 from SpO2/FiO2 Among Patients Receiving Mechanical Ventilation in China | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Assessment of Non-linear Imputation of PaO2/FiO2 from SpO2/FiO2 Among Patients Receiving Mechanical Ventilation in China Shan Wang, Liga Yusvirazi, Haiyan Yin, Hongjun Kang, Yan Zhao, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-861102/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objectives: Arterial blood gas measurements are not always immediately available despite their potential relevance to management of mechanically ventilated patients. Retrospective and prospective studies have validated the non-linear imputation of PaO2/FIO2 from SpO2/FIO2, predominantly in USA. In this study, the objective was to validate the non-linear imputation algorithm among mechanically ventilated patients in the Chinese population. Method: Mechanically ventilated patients admitted to the emergency departments or ICUs at two participating hospitals in China were enrolled prospectively. At the time of a clinical arterial blood gas being drawn, SpO2, oximeter waveform characteristics, receipt of vasopressor, and skin pigmentation were simultaneously recorded. For the various imputation methods, we calculated both imputation error and the area under the curve for patients meeting criteria for acute respiratory distress syndrome (PaO2/FIO2 ≤ 300) and moderate-severe acute respiratory distress syndrome (PaO2/FIO2 ≤ 150). Result: We studied 663 arterial blood gases from 646 patients; 177 (26%) arterial blood gases were associated with SpO2 less than or equal to 96%. Non-linear imputation had lower mean absolute error than linear imputation method when SpO2 was less than or equal to 96% (p<0.001). At the PaO2/FiO2 threshold of 300 or less, non-linear imputation AUC (0.90 95% CI 0.85-0/95) was not significantly higher than the AUCs of linear and log-linear imputation methods (0.88 95% CI 0.82-0.94). The same result was shown at the PaO2 /FiO2 threshold of 150 or less. For patients with a threshold SpO2 of 96% or less, AUC analysis yielded similar results between non-linear vs. linear and log-linear imputations. Conclusions: In this cohort of mechanically ventilated patients, non-linear imputation was not superior to linear and log-linear imputations for patients with SpO2 of 96% or less. All strategies performed similarly in estimating PaO2/FIO2 from SpO2/FIO2. Critical Care & Emergency Medicine sequential organ failure assessment pulse oximetry acute respiratory distress syndrome severity scores Figures Figure 1 Full Text Tables Due to technical limitations, tables 1 to 4 are only available as a download in the Supplemental Files section. Supplementary Files Tablesfiguresandsupplement.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-861102","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":50755781,"identity":"97a5aaa0-011d-4b5f-b948-6f07b6834206","order_by":0,"name":"Shan Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABHElEQVRIiWNgGAWjYNCCH2zMDAzMB0BMHogIGwODAQ8eHYw9fOxAVQlgLTxEaWFgk+MHKjZgQFiDR4v8jORnD7/wmEkzsJ/5upmHwU7GXiLHgOFD2WEGc54DWLUY3EgzN5axSDNm4MnddpuHIZmHB6iFcca5wwyWvQ3YtUgnmElL8BxLtr/BC9JyAKyFmbftMIPBeRwOm53+TVqC7X99gwTPM4SWv3i0MNzOMZP8wAYMZAkeNoQWRpCWszgcdv9NmTRjD1ALT5rZzTkGQL+ceVZwsOdcOo/BGezel+85vk3yBygq2Q8/u/Gmws6evT1544MfZdZyBmcScLgMGO2wCGACR41AAgPIeLwRyfgDhcGP3T2jYBSMglEwcgEAqupTw5TSca0AAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0003-1614-3092","institution":"City University of Hong Kong","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Shan","middleName":"","lastName":"Wang","suffix":""},{"id":50755782,"identity":"967c80f2-7968-416b-a099-57e2b6c157aa","order_by":1,"name":"Liga Yusvirazi","email":"","orcid":"","institution":"Kaiser Permanente","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Liga","middleName":"","lastName":"Yusvirazi","suffix":""},{"id":50755783,"identity":"40bad569-d1f1-4181-9740-ada67e2462d9","order_by":2,"name":"Haiyan Yin","email":"","orcid":"","institution":"Jinan University First Affiliated Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Haiyan","middleName":"","lastName":"Yin","suffix":""},{"id":50755784,"identity":"53e38521-a229-429c-b72d-6f1ad0bdae15","order_by":3,"name":"Hongjun Kang","email":"","orcid":"","institution":"Chinese PLA General Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hongjun","middleName":"","lastName":"Kang","suffix":""},{"id":50755785,"identity":"e117cd25-0d76-4c7c-835f-61ac29bf3e53","order_by":4,"name":"Yan Zhao","email":"","orcid":"","institution":"Chinese PLA General Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yan","middleName":"","lastName":"Zhao","suffix":""},{"id":50755786,"identity":"c7b866ab-03ea-49b3-9aff-f7e2789d6b36","order_by":5,"name":"Li Wang","email":"","orcid":"","institution":"Chinese PLA General Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Wang","suffix":""},{"id":50755787,"identity":"b26e7f79-d55b-4fe0-8150-ad352b62658a","order_by":6,"name":"Samuel M. Brown","email":"","orcid":"","institution":"Intermountain Medical Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Samuel","middleName":"M.","lastName":"Brown","suffix":""},{"id":50755788,"identity":"0501362b-1536-48c4-93fe-fd2e05c9ac30","order_by":7,"name":"Peter C. Hou","email":"","orcid":"","institution":"Brigham and Women's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Peter","middleName":"C.","lastName":"Hou","suffix":""}],"badges":[],"createdAt":"2021-08-31 10:43:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-861102/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-861102/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13320006,"identity":"8a151f2e-f7ad-4f0e-8774-38df7805a0dd","added_by":"auto","created_at":"2021-09-13 15:21:48","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":91717,"visible":true,"origin":"","legend":"Bland-Altman plot of the difference between measured and imputed Pao2/Fio2 (PF) ratios. Blue represents nonlinear, red represents linear, and green represents log-linear imputation results. ABG = arterial blood gas.","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-861102/v1/55ee92afd2c5a56137bc0374.png"},{"id":13678628,"identity":"e2a5c817-f0c2-4a1d-873e-d5839419a98f","added_by":"auto","created_at":"2021-09-17 11:40:07","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":268586,"visible":true,"origin":"","legend":"","description":"","filename":"AssessmentofNonlinearImputation.pdf","url":"https://assets-eu.researchsquare.com/files/rs-861102/v1_covered.pdf"},{"id":13320008,"identity":"a192ac43-62f4-4d28-9d43-38a76d287148","added_by":"auto","created_at":"2021-09-13 15:21:54","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":265084,"visible":true,"origin":"","legend":"","description":"","filename":"AssessmentofNonlinearImputation.pdf","url":"https://assets-eu.researchsquare.com/files/rs-861102/v1_covered.pdf"},{"id":13320007,"identity":"b403ce3e-96c0-40e7-a18f-571484519a67","added_by":"auto","created_at":"2021-09-13 15:21:48","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":392980,"visible":true,"origin":"","legend":"","description":"","filename":"Tablesfiguresandsupplement.pdf","url":"https://assets-eu.researchsquare.com/files/rs-861102/v1/9dd277ad2a5cc59f18ed3a8a.pdf"}],"financialInterests":"","formattedTitle":"Assessment of Non-linear Imputation of PaO2/FiO2 from SpO2/FiO2 Among Patients Receiving Mechanical Ventilation in China","fulltext":[{"header":"Full Text","content":"This preprint is available for \u003ca href='/article/rs-861102/latest.pdf' target='_blank'\u003edownload as a PDF\u003c/a\u003e."},{"header":"Tables","content":"\u003cp\u003eDue to technical limitations, tables 1 to 4 are only available as a download in the Supplemental Files section.\u003c/p\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"sequential organ failure assessment, pulse oximetry, acute respiratory distress syndrome, severity scores","lastPublishedDoi":"10.21203/rs.3.rs-861102/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-861102/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives:\u003c/strong\u003e Arterial blood gas measurements are not always immediately available despite their potential relevance to management of mechanically ventilated patients. Retrospective and prospective studies have validated the non-linear imputation of PaO2/FIO2 from SpO2/FIO2, predominantly in USA. In this study, the objective was to validate the non-linear imputation algorithm among mechanically ventilated patients in the Chinese population. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e Mechanically ventilated patients admitted to the emergency departments or ICUs at two participating hospitals in China were enrolled prospectively. At the time of a clinical arterial blood gas being drawn, SpO2, oximeter waveform characteristics, receipt of vasopressor, and skin pigmentation were simultaneously recorded. For the various imputation methods, we calculated both imputation error and the area under the curve for patients meeting criteria for acute respiratory distress syndrome (PaO2/FIO2 ≤ 300) and moderate-severe acute respiratory distress syndrome (PaO2/FIO2 ≤ 150). \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResult:\u003c/strong\u003e We studied 663 arterial blood gases from 646 patients; 177 (26%) arterial blood gases were associated with SpO2 less than or equal to 96%. Non-linear imputation had lower mean absolute error than linear imputation method when SpO2 was less than or equal to 96% (p\u0026lt;0.001). At the PaO2/FiO2 threshold of 300 or less, non-linear imputation AUC (0.90 95% CI 0.85-0/95) was not significantly higher than the AUCs of linear and log-linear imputation methods (0.88 95% CI 0.82-0.94). The same result was shown at the PaO2 /FiO2 threshold of 150 or less. For patients with a threshold SpO2 of 96% or less, AUC analysis yielded similar results between non-linear vs. linear and log-linear imputations. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e In this cohort of mechanically ventilated patients, non-linear imputation was not superior to linear and log-linear imputations for patients with SpO2 of 96% or less. All strategies performed similarly in estimating PaO2/FIO2 from SpO2/FIO2.\u003c/p\u003e","manuscriptTitle":"Assessment of Non-linear Imputation of PaO2/FiO2 from SpO2/FiO2 Among Patients Receiving Mechanical Ventilation in China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-09-13 15:21:46","doi":"10.21203/rs.3.rs-861102/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a520aa77-40d7-4a1e-9b33-3bf2208348ca","owner":[],"postedDate":"September 13th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":7133986,"name":"Critical Care \u0026 Emergency Medicine"}],"tags":[],"updatedAt":"2021-09-13T15:21:48+00:00","versionOfRecord":[],"versionCreatedAt":"2021-09-13 15:21:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-861102","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-861102","identity":"rs-861102","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}